The international, medical humanitarian organisation, Médecins Sans Frontières/Doctors Without Borders(MSF), calls for a fast-tracked development of integrated Visceral Leishmaniasis (VL) or kala azar and HIV guidelines to ensure a multidisciplinary approach towards treating those affected by this coinfection.

While commending the National AIDS Control Organisation (NACO) and the National Vector Borne Disease Control Programme (NVBDCP) for their efforts to develop a national protocol for multidisciplinary case management guidelines to deal with HIV-VL coinfection, MSF believes that counselling and testing for all kala azar patients must be made available and proper diagnosis and treatment given to HIV patients in areas where kala azar is endemic.

'State level support' is needed

A recent MSF study conducted in Bihar, India, where kala azar is endemic, indicates an increase in the rate of HIV-VL coinfection. The study estimates the rate of HIV-VL coinfection among the kala azar patients treated by MSF to be 5.6 percent. This is a much higher number compared to the background HIV prevalence of 0.22 percent in Bihar.

The study examined 2,130 people from the age of 14 already diagnosed with VL or kala azar. 2,077 of the patients agreed to voluntary testing. Of these, 5.6 percent (117) were found to be HIV positive, of whom 2.4 percent of the patients did not know their HIV status before.

“While there is commitment and willingness at the national level to implement the guidelines, state level support and action is also needed to ensure that testing and treatment for HIV-VL coinfection is made more accessible in kala azar endemic areas,” said Dr Prince Mathew, MSF’s Deputy Country Director in India.

Elimination is the goal

More than 70 percent of all VL cases in India are reported from Bihar. However, there is limited data on the magnitude of HIV-VL coinfection and the best treatment regimens. Moreover, low cure rates and high risks of disease relapses among coinfected patients demand that a multidisciplinary approach towards treating this group of patients is deployed.

MSF believes it is time to accelerate the efforts at the state level to ensure greater access to diagnosis and treatment of HIV-VL coinfection not only for individual treatment success, but also for kala azar elimination.